Neoadjuvant-Intent Immunotherapy in Advanced, Resectable Cutaneous Squamous Cell Carcinoma

Area of Science:

• Oncology
• Immunotherapy
• Dermatology

Background:

• Preoperative immune checkpoint inhibitors (ICIs) demonstrate clinical activity in advanced cutaneous squamous cell carcinoma (cSCC).
• Previous clinical trials often excluded patients with significant comorbidities, limiting real-world applicability.

Purpose of the Study:

• To assess radiologic and pathologic response rates to neoadjuvant-intent programed cell death protein 1 (PD-1) ICIs in a diverse clinical population.
• To evaluate survival outcomes including recurrence-free, progression-free, disease-specific, and overall survival.

Main Methods:

• A cohort study involving 27 patients with advanced cSCC treated with neoadjuvant cemiplimab or pembrolizumab between January 2018 and January 2023.
• Median follow-up was 9.5 months, with assessment of radiologic and pathologic response rates, and survival endpoints.

Main Results:

• An overall pathologic response rate of 47.4% and a radiologic response rate of 50.0% were observed.
• Pathologic complete response (pCR) rate was 36.8%. One-year survival rates were high: recurrence-free (90.9%), progression-free (83.3%), disease-specific (91.7%), and overall (84.6%).
• Notably, 18.5% of patients declined surgery due to tumor response or stability.

Conclusions:

• Neoadjuvant-intent immunotherapy for cSCC is reproducible in a clinical setting, even in patients with comorbidities such as a history of lymphoma.
• The study highlights that in real-world practice, patients may forgo surgery for regressing tumors, and inclusion of higher-risk patients may influence response rates.